By providing you with health and dental benefits, the ETFO Employee Life and Health Trust (ELHT) is working to take care of the health and wellness of you and your family.
That is why it is a shared responsibility between you and the ETFO ELHT to protect your health and dental benefits from abuse, misuse, and fraud.
If benefits are abused, it impacts everyone. It can increase the cost of the benefits plan, resulting in increased premiums or in some cases, reduced or lost coverage.
Some service providers can also commit benefit abuse. Claims from providers deemed to be fraudulent by Manulife, will not be approved.
To view a list of Manulife’s uncovered providers, log in to OTIP’s secure member site at www.otip.com and go to the Wellness centre in My Claims. Members can also call OTIP Benefits Services at 1-866-783-6847 to inquire about these providers. Be sure to check this list to minimize delays to your claims.
Here are some examples of benefits abuse:
Working closely with Manulife (insurer) and OTIP (plan administrator), the ETFO ELHT is responding to benefits fraud and abuse.
ALL submitted claims go through advanced analytics to identify potential benefits abuse and fraudulent activity.
The staff and systems used for handling claims are constantly being monitored with various detection tools including:
Manulife routinely and randomly audits benefit claims. For example, a claim audit questionnaire may be sent to you via letter or email to:
To minimize delays in paying you or your service provider, be sure to complete and send the questionnaire back to Manulife as soon as possible.
In addition, your ETFO ELHT has an Anti-fraud Policy. When a member is identified as committing benefits fraud, actions taken by the ETFO ELHT will include but are not limited to:
Knowing how to recognize benefits abuse will help you to refuse it and/or avoid taking part. Test your benefits abuse IQ! Take OTIP’s short quiz.
Want to learn more about how you can help protect your benefits? Check out these articles!